세계의 의료 부정 적발 시장 보고서(2025년)
Healthcare Fraud Detection Global Market Report 2025
상품코드 : 1821635
리서치사 : The Business Research Company
발행일 : On Demand Report
페이지 정보 : 영문 250 Pages
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한글목차

의료 부정 적발 시장 규모는 향후 몇 년 동안 비약적인 성장이 예상됩니다. 2029년 연평균 성장률(CAGR)은 30.9%로 136억 6,000만 달러에 달할 것으로 예상됩니다. 예측 기간의 성장은 규제 변화, 디지털화 진행, 사기 수법의 고도화, 보험 사기에 대한 집중, 데이터 보안 강화 등에 기인합니다. 예측 기간의 주요 동향으로는 첨단 기술 통합, 실시간 모니터링, 행동 분석, 보안을 위한 블록체인, 환자 신원 확인 등이 있습니다.

향후 5년간 성장률 30.9%라는 예측은 지난번 예측보다 0.2% 소폭 하락한 수치입니다. 이 감소는 주로 미국과 다른 국가 간의 관세의 영향에 기인합니다. 관세 부과로 인해 에스토니아나 프랑스에서 수입되는 인공지능(AI) 기반 부정행위 분석 플랫폼과 이상 징후 감지 소프트웨어의 비용이 상승하고, 클레임의 무결성이 손상되고, 보험 감독 비용이 증가하여 미국 보험사 시스템에 혼란을 초래할 수 있습니다. 또한, 상호 관세와 무역 긴장과 제한의 증가로 인한 세계 경제와 무역에 대한 악영향으로 인해 그 영향은 더욱 광범위하게 나타날 것으로 보입니다.

헬스케어 분야에서의 부정행위 증가는 의료 부정 적발 시장의 성장을 촉진할 것으로 예상됩니다. 의료 분야의 부정행위에는 부정하거나 불법적인 이익을 얻거나 이용자의 법적 권리를 부정하기 위해 환자 정보나 보험 정보를 의도적으로 허위로 기재하는 행위가 포함됩니다. 예를 들어, 영국에 본사를 둔 금융기관의 보고에 따르면, 2022년에 Authorized Push Payment(APP) 사기가 20만 7,372건 발생하여 총 손실액이 4억 8,520만 파운드에 달해 2021년 대비 17% 감소했습니다. 그 결과, 헬스케어 산업에서 부정행위의 증가는 의료 부정 적발 솔루션에 대한 수요를 촉진할 것으로 예상됩니다.

목차

제1장 주요 요약

제2장 시장 특징

제3장 시장 동향과 전략

제4장 시장 : 금리, 인플레이션, 지정학, 무역 전쟁과 관세, 그리고 코로나와 회복이 시장에 미치는 영향을 포함한 거시경제 시나리오

제5장 세계의 성장 분석과 전략 분석 프레임워크

제6장 시장 세분화

제7장 지역별·국가별 분석

제8장 아시아태평양 시장

제9장 중국 시장

제10장 인도 시장

제11장 일본 시장

제12장 호주 시장

제13장 인도네시아 시장

제14장 한국 시장

제15장 서유럽 시장

제16장 영국 시장

제17장 독일 시장

제18장 프랑스 시장

제19장 이탈리아 시장

제20장 스페인 시장

제21장 동유럽 시장

제22장 러시아 시장

제23장 북미 시장

제24장 미국 시장

제25장 캐나다 시장

제26장 남미 시장

제27장 브라질 시장

제28장 중동 시장

제29장 아프리카 시장

제30장 경쟁 구도와 기업 개요

제31장 기타 주요 기업과 혁신적 기업

제32장 세계의 시장 경쟁 벤치마킹과 대시보드

제33장 주요 인수합병

제34장 최근의 시장 동향

제35장 시장 잠재력이 높은 국가, 부문, 전략

제36장 부록

KSM
영문 목차

영문목차

Healthcare fraud detection involves measures taken to prevent individuals from acquiring patient data or assets through deceptive means. This encompasses auditing accounts and conducting investigative procedures to ensure transparency, accountability, and risk assessment. Its aim is to identify, prevent, and manage potential instances of fraud, waste, or abuse, thereby reducing the compromise of sensitive patient information like medical records.

The primary categories of healthcare fraud detection comprise descriptive, predictive, and prescriptive analytics. Descriptive analytics, leveraging historical and current data, unearth patterns and connections to flag suspicious activities. These analytics support the management of medical imaging, clinical data, and outcomes. There are two delivery models such as on-premise and on-demand, utilizing services and software components. These methods find application in insurance claim reviews and payment integrity, serving healthcare payers, government bodies, and other stakeholders.

Note that the outlook for this market is being affected by rapid changes in trade relations and tariffs globally. The report will be updated prior to delivery to reflect the latest status, including revised forecasts and quantified impact analysis. The report's Recommendations and Conclusions sections will be updated to give strategies for entities dealing with the fast-moving international environment.

The sharp rise in U.S. tariffs and the resulting trade tensions in spring 2025 are having a significant impact on the healthcare sector, especially in the supply of essential medical devices, diagnostic equipment, and pharmaceuticals. Hospitals and healthcare providers are grappling with higher costs for imported surgical tools, imaging systems, and consumables like syringes and catheters, many of which have limited domestic substitutes. These escalating expenses are putting pressure on healthcare budgets, prompting some providers to delay equipment upgrades or pass increased costs on to patients. Furthermore, tariffs on raw materials and components are disrupting the manufacturing of vital drugs and devices, leading to supply chain delays. In response, the industry is adopting diversified sourcing strategies, expanding local production where feasible, and pushing for tariff exemptions on critical medical products.

The healthcare fraud detection market research report is one of a series of new reports from The Business Research Company that provides healthcare fraud detection market statistics, including healthcare fraud detection industry global market size, regional shares, competitors with an healthcare fraud detection market share, detailed healthcare fraud detection market segments, market trends and opportunities, and any further data you may need to thrive in the healthcare fraud detection industry. This healthcare fraud detection market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.

The healthcare fraud detection market size has grown exponentially in recent years. It will grow from $3.62 billion in 2024 to $4.66 billion in 2025 at a compound annual growth rate (CAGR) of 28.6%. The growth in the historic period can be attributed to increased cyberthreats, patient identity verification, market competition, fraudulent claim identification, increased awareness and training.

The healthcare fraud detection market size is expected to see exponential growth in the next few years. It will grow to $13.66 billion in 2029 at a compound annual growth rate (CAGR) of 30.9%. The growth in the forecast period can be attributed to regulatory changes, increasing digitalization, sophistication of fraud schemes, focus on insurance fraud, data security enhancement. Major trends in the forecast period include advanced technology integration, real-time monitoring, behavioral analytics, blockchain for security, patient identity verification.

The forecast of 30.9% growth over the next five years reflects a slight reduction of 0.2% from the previous projection. This reduction is primarily due to the impact of tariffs between the US and other countries. The imposition of tariffs may disrupt U.S. payer systems by increasing costs for Artificial intelligence(AI)-powered fraud analytics platforms and anomaly detection software imported from Estonia and France, potentially compromising claims integrity and raising insurance oversight expenses. The effect will also be felt more widely due to reciprocal tariffs and the negative effect on the global economy and trade due to increased trade tensions and restrictions.

The increasing incidence of fraudulent activities in the healthcare sector is anticipated to drive the growth of the healthcare fraud detection market. Fraudulent events in healthcare involve the intentional misrepresentation of patient information and insurance details to gain unfair or illegal benefits or to deny a user their legal rights. For example, a report from a UK-based financial organization indicated that in 2022, there were 207,372 cases of Authorized Push Payment (APP) fraud, resulting in total losses of £485.2 million, which represents a 17% decrease compared to 2021. Consequently, the rise in fraudulent occurrences within the healthcare industry is expected to propel the demand for healthcare fraud detection solutions.

The ongoing digital transformation in healthcare is projected to significantly boost the growth of the healthcare fraud detection market in the future. As healthcare processes become increasingly digitized, the rising volume and complexity of electronic data, combined with the integration of advanced technologies such as artificial intelligence and machine learning, create an environment conducive to potential fraudulent activities. Digital transformation facilitates real-time monitoring, streamlined data sharing, and improved security measures, enabling fraud detection systems to swiftly identify irregularities. Moreover, the implementation of electronic health records, remote healthcare services, and electronic claims processing requires robust fraud detection solutions to protect against unauthorized access and fraudulent activities. For instance, a report published by gov.UK in February 2024 noted that in 2022, the digital sector contributed approximately $171.25 million to the UK economy, representing 7.2% of the total UK gross value added (GVA), which is a slight increase from 7.1% in 2021. Thus, the rise of digital transformation in healthcare is driving the expansion of the healthcare fraud detection market.

The adoption of advanced analytics tools emerges as a significant trend gaining traction within the healthcare fraud detection landscape. Key industry players are channeling efforts into crafting innovative technologies to maintain their foothold in the healthcare fraud detection sphere. For instance, in January 2022, Premier, Inc., a US-based healthcare technology company, introduced 'INSights' built upon PINC AITM technology. INSights stand as a vendor-neutral analytics platform harnessing risk-adjusted, standardized, and cleansed healthcare data from PINC AITM. Tailored for healthcare providers, INSights aim to alleviate the burden associated with data preparation and analytics development, enabling rapid improvements in clinical, quality, and financial outcomes.

Leading companies within the healthcare fraud detection arena are innovating new insurance fraud detection solutions to gain a competitive edge. For example, in June 2023, Verisk Analytics, Inc., a US-based analytics company, collaborated with Kyndryl Holdings, Inc. to introduce an advanced technology suite targeting insurance fraud prevention in Israel's compulsory insurance market. Leveraging Kyndryl's robust computing resources and Verisk's domain expertise, this solution fortified the anti-fraud engine for real-time monitoring of auto claims concerning bodily injury. Supported by round-the-clock managed services and advanced analytics, the system verified applicant details against databases and government sources, facilitating comprehensive data investigations for insurance claim adjusters. This collaboration aimed to streamline claims processes, detect potential fraud, and meet evolving consumer expectations in the digitized insurance landscape.

In October 2022, Levio Conseils Inc., a Canadian digital consulting firm specializing in information technology and organizational management, acquired Indellient for an undisclosed amount. This acquisition is intended to help Levio Conseils Inc. expand its service offerings, strengthen its market presence, and leverage new technologies to enhance client services. Indellient, also based in Canada, specializes in software development, cloud solutions, and digital transformation services.

Major companies operating in the healthcare fraud detection market are International Business Machines Corporation, Cotiviti Inc., Fair Isaac Corporation, SAS Institute Inc., CGI Inc., DXC Technology Company, RELX Group PLC, EXL Service Holdings Inc., HCL Technologies Limited, UnitedHealth Group Incorporated, Conduent Incorporated, Change Healthcare LLC, OSP Labs LLC, Codoxo Inc., Wipro Limited, Qlarant Inc., Northrop Grumman Corporation, LexisNexis Risk Solutions Group, Healthcare Fraud Shield LLC, Sharecare Inc., FraudLens Inc., HMS Holdings Corp., H2O.ai Inc., Pondera Solutions Inc., FRISS B.V., MultiPlan Corporation, FraudScope Inc., McKesson Corporation, FraudGuard LLC, FraudCracker LLC

North America was the largest region in the healthcare fraud detection market in 2024. The regions covered in the healthcare fraud detection market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa.

The countries covered in the healthcare fraud detection market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Canada, Italy, Spain.

The health fraud detection market includes revenues earned by entities by tracking secondary data, providing technology specialist. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.

Healthcare Fraud Detection Global Market Report 2025 from The Business Research Company provides strategists, marketers and senior management with the critical information they need to assess the market.

This report focuses on healthcare fraud detection market which is experiencing strong growth. The report gives a guide to the trends which will be shaping the market over the next ten years and beyond.

Reasons to Purchase

Where is the largest and fastest growing market for healthcare fraud detection ? How does the market relate to the overall economy, demography and other similar markets? What forces will shape the market going forward, including technological disruption, regulatory shifts, and changing consumer preferences? The healthcare fraud detection market global report from the Business Research Company answers all these questions and many more.

The report covers market characteristics, size and growth, segmentation, regional and country breakdowns, competitive landscape, market shares, trends and strategies for this market. It traces the market's historic and forecast market growth by geography.

The forecasts are made after considering the major factors currently impacting the market. These include the technological advancements such as AI and automation, Russia-Ukraine war, trade tariffs (government-imposed import/export duties), elevated inflation and interest rates.

Scope

Table of Contents

1. Executive Summary

2. Healthcare Fraud Detection Market Characteristics

3. Healthcare Fraud Detection Market Trends And Strategies

4. Healthcare Fraud Detection Market - Macro Economic Scenario Including The Impact Of Interest Rates, Inflation, Geopolitics, Trade Wars and Tariffs, And Covid And Recovery On The Market

5. Global Healthcare Fraud Detection Growth Analysis And Strategic Analysis Framework

6. Healthcare Fraud Detection Market Segmentation

7. Healthcare Fraud Detection Market Regional And Country Analysis

8. Asia-Pacific Healthcare Fraud Detection Market

9. China Healthcare Fraud Detection Market

10. India Healthcare Fraud Detection Market

11. Japan Healthcare Fraud Detection Market

12. Australia Healthcare Fraud Detection Market

13. Indonesia Healthcare Fraud Detection Market

14. South Korea Healthcare Fraud Detection Market

15. Western Europe Healthcare Fraud Detection Market

16. UK Healthcare Fraud Detection Market

17. Germany Healthcare Fraud Detection Market

18. France Healthcare Fraud Detection Market

19. Italy Healthcare Fraud Detection Market

20. Spain Healthcare Fraud Detection Market

21. Eastern Europe Healthcare Fraud Detection Market

22. Russia Healthcare Fraud Detection Market

23. North America Healthcare Fraud Detection Market

24. USA Healthcare Fraud Detection Market

25. Canada Healthcare Fraud Detection Market

26. South America Healthcare Fraud Detection Market

27. Brazil Healthcare Fraud Detection Market

28. Middle East Healthcare Fraud Detection Market

29. Africa Healthcare Fraud Detection Market

30. Healthcare Fraud Detection Market Competitive Landscape And Company Profiles

31. Healthcare Fraud Detection Market Other Major And Innovative Companies

32. Global Healthcare Fraud Detection Market Competitive Benchmarking And Dashboard

33. Key Mergers And Acquisitions In The Healthcare Fraud Detection Market

34. Recent Developments In The Healthcare Fraud Detection Market

35. Healthcare Fraud Detection Market High Potential Countries, Segments and Strategies

36. Appendix

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